What to Do Between Therapy Sessions: 7 Practices That Actually Help

You see your therapist for about an hour each week. That leaves 167 hours where the work of getting better is entirely up to you.

Most people know that feeling — you leave a session feeling clear, maybe even hopeful, and then by Wednesday you can't quite remember what you were supposed to practice. By the time your next appointment comes around, you spend the first fifteen minutes catching your therapist back up instead of moving forward.

That gap between sessions isn't wasted time. Research shows it's actually where most of the growth happens — if you know what to do with it.

A 2010 meta-analysis of 23 studies found a consistent relationship between practicing skills outside of therapy and better outcomes (effect size r = .26). A more recent 2024 review from researchers at the Norwegian University of Science and Technology and Monash University put the causal effect even higher — a medium effect size (d = .53) for between-session practice on treatment results.

What you do between sessions matters at least as much as what happens during them.

Here are seven practices that research supports — and that you can start today.

1. Check in with yourself for 10 seconds

You don't need a long journaling session. Just pause once a day and ask: How am I feeling right now? Name it. One word is enough.

This isn't fluffy self-care advice. Self-monitoring of mood is a core component of behavioral activation, one of the most effective treatments for depression. Researchers have found that the simple act of noticing and naming emotions begins to change your relationship with them.

You can do this on paper, in a notes app, or with a mood tracking app. The point is consistency, not depth.

2. Try a 2-minute breathing exercise

Breathing exercises aren't just relaxation tools — they produce measurable physiological changes. A 2023 systematic review of 58 studies found that 54 of 72 distinct breathing interventions were effective at reducing stress and anxiety.

A Stanford randomized controlled trial compared box breathing (equal inhale-hold-exhale cycles) to other techniques and found that structured breathing reduced state anxiety and negative emotion — and performed better than mindfulness meditation alone.

Try this: Inhale for 4 counts, hold for 4, exhale for 4, hold for 4. Repeat for 2 minutes. That's box breathing — and it's one of the simplest evidence-based tools you can practice anywhere.

3. Keep a simple thought record

Thought records are the backbone of Cognitive Behavioral Therapy (CBT). The idea is straightforward: when you notice a strong negative emotion, write down the situation, the automatic thought that came with it, and then ask whether that thought is the full picture.

The American Psychological Association publishes a 5-step cognitive restructuring process that walks you through this. It doesn't have to be elaborate — even a few sentences help.

Why does writing matter? Because the act of externalizing a thought changes how your brain processes it. You move from being the thought to looking at the thought. That shift is where CBT does its work.

4. Practice grounding when anxiety spikes

If anxiety tends to hit you between sessions, grounding techniques give you something concrete to do in the moment.

The 5-4-3-2-1 technique is one of the most widely used: name 5 things you can see, 4 you can touch, 3 you can hear, 2 you can smell, and 1 you can taste. According to the University of Rochester Medical Center, this works by activating your prefrontal cortex — the reasoning part of your brain — which helps regulate the amygdala (your emotional alarm system).

It takes about 60 seconds and you can do it sitting at your desk, on a bus, or lying in bed at 2 a.m.

5. Do one small thing on purpose

Behavioral activation is a simple idea: when you're feeling low, doing something — almost anything — that aligns with what you care about can shift your mood. It doesn't have to be big. Walk around the block. Text a friend. Cook something.

A Cochrane review of 53 studies found that behavioral activation is as effective as full CBT for depression. The key insight is that you don't have to feel like doing something before you do it. Action can come first; motivation often follows.

If your therapist gives you specific exercises to try between sessions, this is the spirit behind them. Start small. One thing. Today.

6. Sit with discomfort instead of fighting it

This one comes from Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT). The idea goes against instinct: trying to push away a difficult feeling often makes it stronger.

DBT teaches a skill called STOP: Stop what you're doing, Take a step back, Observe what's happening inside you, then Proceed mindfully. It's designed as emotional first aid — a way to interrupt the spiral before it takes over.

ACT takes a different angle with cognitive defusion — exercises that help you notice thoughts without getting caught up in them. One example: repeat a distressing thought in a silly voice. It sounds strange, but the point is to create distance between you and the thought, so you can choose how to respond rather than reacting automatically.

7. Write a quick note for your therapist

One of the most practical things you can do between sessions is keep a running note of what you want to bring up next time. It doesn't have to be long. A few bullet points: what happened this week, what you practiced, what felt hard, what you want to talk about.

This solves two problems. First, you won't forget the thing that seemed important on Tuesday but vanished from memory by Thursday. Second, your therapist can spend less time on recap and more time helping you move forward.

Some people keep a note in their phone. Some use a journal. And some use tools specifically designed to bridge the gap between sessions — which is exactly why we built BridgeCalm.

The common thread

All seven of these practices share something: they're small, they take minutes (not hours), and they work best when done consistently. Research on digital micro-interventions confirms that brief daily practices, delivered in context, are an effective building-block approach to mental health improvement.

You don't need to do all seven. Start with one. The practice that works is the one you'll actually do.

How BridgeCalm helps

BridgeCalm was designed around exactly this problem. Jan, your wellness companion, walks you through these kinds of exercises daily — a 10-second mood check-in, a guided breathing exercise, a thought challenge. She remembers what you've practiced and, if you have a therapist, sends them a brief summary before your next session.

It's not therapy. It's the part between therapy that makes therapy work better.

[Try BridgeCalm free →]

Sources

• Mausbach, B.T., et al. (2010). "The Relationship Between Homework Compliance and Therapy Outcomes: An Updated Meta-Analysis." Cognitive Therapy and Research. PMC2939342
• Ryum, T. & Kazantzis, N. (2024). "Between-Session Homework in Clinical Training and Practice." Clinical Psychology in Europe. PMC11303922
• Ramos Vieira, B.C., et al. (2023). "Breathing Practices for Stress and Anxiety Reduction: Systematic Review." Brain Sciences. PMC10741869
• Balban, M.Y., et al. (2023). "Brief structured respiration practices enhance mood and reduce physiological arousal." Cell Reports Medicine. PMC9873947
• Souza-Talarico, J.N., et al. (2022). "Behavioral Activation for Depression: A Narrative Review." International Journal of Environmental Research and Public Health. PMC9082162
• Aguilera, A. (2020). "Digital Micro Interventions for Behavioral and Mental Health Gains." JMIR. PMC7661243
• American Psychological Association. "5 Steps of Cognitive Restructuring." APA Handout
• University of Rochester Medical Center. "5-4-3-2-1 Coping Technique for Anxiety." URMC